Department of Psychiatry and Psychology, Neurological Institute, Cleveland Clinic , Cleveland, OH , USA.
Department of Psychology in Education, University of Pittsburgh , Pittsburgh, PA , USA.
Front Neurol. 2014 Feb 19;5:18. doi: 10.3389/fneur.2014.00018. eCollection 2014.
Children with epilepsy have a high rate of mood and behavior problems; yet few studies consider the emotional and behavioral impact of surgery. No study to date has been sufficiently powered to investigate effects of both side (left/right) and site (temporal/frontal) of surgery. One hundred patients (aged 6-16) and their families completed measures of depression, anxiety, and behavioral function as part of neuropsychological evaluations before and after surgery for pharmacoresistant epilepsy. Among children who had left-sided surgeries (frontal = 16; temporal = 38), there were significant interactions between time (pre to post-operative neuropsychological assessment) and resection site (frontal/temporal) on anhedonia, social anxiety, and withdrawn/depressed scales. Patients with frontal lobe epilepsy (FLE) endorsed greater pre-surgical anhedonia and social anxiety than patients with temporal lobe epilepsy (TLE) with scores normalizing following surgery. While scores on the withdrawn/depressed scale were similar between groups before surgery, the FLE group showed greater symptom improvement after surgery. In children who underwent right-sided surgeries (FLE = 20; TLE = 26), main effects of time (patients in both groups improved) and resection site (caregivers of FLE patients endorsed greater symptoms than those with TLE) were observed primarily on behavior scales. Individual data revealed that a greater proportion of children with left FLE demonstrated clinically significant improvements in anhedonia, social anxiety, and aggressive behavior than children with TLE. This is the first study to demonstrate differential effects of both side and site of surgery in children with epilepsy at group and individual levels. Results suggest that children with FLE have greater emotional and behavioral dysfunction before surgery, but show marked improvement after surgery. Overall, most children had good emotional and behavioral outcomes, with most scores remaining stable or improving.
患有癫痫的儿童情绪和行为问题发生率较高；然而，很少有研究考虑手术对情绪和行为的影响。迄今为止，没有一项研究有足够的能力来调查手术侧（左/右）和部位（颞叶/额叶）的影响。100 名（6-16 岁）患儿及其家属在药物难治性癫痫手术后，完成了抑郁、焦虑和行为功能的测量，作为神经心理学评估的一部分。在接受左侧手术（额叶=16；颞叶=38）的儿童中，在术前和术后神经心理学评估之间，存在时间（时间）和切除术部位（额叶/颞叶）之间的显著交互作用在快感缺乏、社交焦虑和退缩/抑郁量表上。额叶癫痫（FLE）患者的术前快感缺乏和社交焦虑评分高于颞叶癫痫（TLE）患者，术后评分正常化。尽管手术前两组患者在退缩/抑郁量表上的评分相似，但 FLE 组在手术后的症状改善更大。在接受右侧手术的儿童中（FLE=20；TLE=26），观察到时间（两组患者均有所改善）和切除术部位（FLE 患者的照料者比 TLE 患者有更多的症状）的主要影响主要在行为量表上。个体数据显示，与 TLE 患者相比，更多的左侧 FLE 患儿在快感缺乏、社交焦虑和攻击性行为方面表现出显著的临床改善。这是第一项在组和个体水平上研究癫痫儿童手术侧和部位的差异影响的研究。结果表明，FLE 患儿术前的情绪和行为功能障碍更大，但术后有明显改善。总的来说，大多数患儿的情绪和行为预后良好，大多数评分保持稳定或改善。
